BACKGROUND AND IMPLEMENTATION CHALLENGES: In 2018, 13% of pregnant women in Greater Manchester smoked at the time of delivery, with the highest rates among disadvantaged populations. Traditional smoking cessation services were inconsistent, resource-intensive, and hindered by fragmented processes. To address these systemic barriers, the Greater Manchester Smokefree Pregnancy Programme introduced a digital pathway including incentives for quitting and staying smokefree to birth and beyond. Challenges included staff resistance, integrating digital tools across ten localities, and ensuring equitable access for vulnerable groups.
INTERVENTION OR RESPONSE: A digital platform was co-designed with midwives, public health experts, and service users to automate referrals, provide real-time data tracking, issue incentive payments and deliver tailored support. Training and engagement sessions equipped healthcare professionals with the skills to adopt the platform. Targeted outreach and culturally sensitive materials addressed health inequities, ensuring accessibility for disadvantaged populations.
RESULTS AND IMPACT:

• Smoking at Time of Delivery (SATOD) rates decreased from 12.6% in 2017/18 to 7.7% in 2023/24, resulting in over 6,000 additional smoke-free births.
• Engagement with cessation services increased by 50%.
• Administrative burdens reduced by 20%, enabling midwives to dedicate more time to patient care.
• Annual financial savings exceeded £11 million from reduced hospital admissions and optimised resources.

The programme has recently been scaled nationally, demonstrating its adaptability and effectiveness in diverse contexts. Patients report feeling empowered to quit smoking, and providers note streamlined workflows and improved service delivery
CONCLUSIONS: This programme highlights how regional initiatives can inform the development of national models, providing valuable lessons for scaling public health innovations. The success of this programme demonstrates the potential of co-designed, digital-first approaches to address health inequalities and improve maternal outcomes. The approach is adaptable to other health challenges, such as obesity or substance use, offering a roadmap for scalable public health solutions.